HomeMy WebLinkAbout122 London Fog Way 12-2484 (re-roof); ;, 1
5EP 2 0 2�12
CITY OF SANFORD
BIJIILDING_&-:FIRE""PREVENTION
a PERMIT APPLICATION
Application No: 4 �y Documented Construction Value: $
Job Address: i a a �Ja-a i-dq Historic District: Yes ❑ No R"'-
Parcel ID: 33 � e) oozy dzao Zoning:
Description of Work:
Plan Review Contact Person: ,'l /ft�4 Title: V- 0-a-S.
Phone: "/0 � -6 � a�_ ax: 3� ) T Y - ANY E-mail: 501i lleje/d /tic - d ✓r, rd.J � ,Cam,
Property Owner Information
Name i�aC3e�r,-�� l 14,4C.V i�[�d�2. rJ Phone: U 7-"
Street: M2 A,010do-AJa Resident of property?
City, State Zip: SAWL-
Contractor Information
Name ( 0Y►� ) AAQI� �/y Phone: �6
Street: c21b ��lyOJ —) iZ� U ADD Fax: �JO�� �l �l '" exC/7
City, State Zip: �� � C"L 3a �� State License No.: Cdd. l 3A 4 U 3
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: Address:
PERMIT INFORMATION
Building Permit
Square Footage: 9,01 Construction Type: No. of Stories: /
No. of Dwelling Units: 1 Flood Zone: jud
Electrical ❑ Plumbing ❑
New Service - No. of AMPS: New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 13 No. of heads:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no
work or installation has commenced prior to the issuance of a permit and that all work will be performed to
meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit
must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and
air conditioners, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE ?OB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this
property that may be found in the public records of this county, and there may be additional permits required
from other governmental entities such as water management districts; state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida
Lien, Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGNEERING:
COMMENTS:
narur �.=WoriAenl Date
C eze.� o 9
Print Contractor/Aeenir%--Alame
ignature of otar to oF-FMi7tlav Date
LORRkINE nODFR1GUEZ
�+ ov Lotary Nblic, State of Florida
$ ,Ommisslon# DD89810 2013
y comm. expires June
UTILITIES:
FIRE:
Contractor/Agent is ersonally Known to Me or
Produced 1D Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
THIS INSTRUMENT PREPARED � �BY' k /r-,
�k- 611M Name: 1�JAJnY 7 L
Address: ID a'`vL+L
?"st
Si SEA/IINOLE COUNITY 1
State Florida
MARYANNE MORSE, CLERK OF CIRCUIT COURT
INOLE COUNTY
@7859 Pg 0315; Qpg)
CLERK'S # 2EII21 12050
RECORDED @9/2@/k-IDId 18;43.-Q PM
RECORDING FEES 1066
RECORDED BY J Eekent•ath(all)
NOTICE OF COMMENCEMENT
q 5- bado o�aa
Permit Number J Parcel ID Number (PID)
The undersigned hereby gives notice that improvement will be made to c2 -in real property, and in accordance with Chapter 713,
Florida Statutes, the following information is provided in this Notice of Commencement
DESCRIPTION OF PROPERTY (LegaAescr<ption of e property and street address if available)
v
GENERAL DESCRIPTION OF IMPROVEMENT �'P lact'S
OWNER INFORMATION r ^
Name and address: )9 t
R,CONTRACTOR
Name and address: 1
Z?
Persons within the State of Floridd Desig
by Section 713.13(1)(b), Florida Statutes.
Name and address:
N `I
by Owner upon
2 S aO
notice or other documents may be served as provided
In addition to himself, Owner Designates of
To receive a copy of the Lienors Notice as Provided in .
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement:
The expiration date is 1 year from date of recording unless a different date is specified.
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
ST'.T O F O dD - COUNTY OF SEMINOLE
WNERS SIGNATURE OWNERS PRINTED NAME �-�
"(NOTE: Per Florida Statute 713.13(1) (g), owner must sign...... and no one else may be permitted to sigh in .is or he\ r stead „
The foregoing instrument was acknowledged before me this _ day of 20
-
by P)hga 6ia-,G,Gy e A, !C Who is personally known to me
Name of pers king statement
OR who has produced Identification type of identification produced
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES.
jf
UNDER PE AL IES, OF RJUR 9 LARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS STATf$d IFS11 I ED COPY �r
ARE RU TO HE E 68F,EAND BELIEF_ MARYANNP MORSL
CLER =OURTSIGNATURE OF NATURAL PERSON SIGNING ABOVE kw JV
8HERYL.QJ2, ENE MILLER ERa
•� %"= MY COMMISSION 0 EE101636
''-
- "Notary Signature
"�f.�� �•' EXPIRES Jung 09, 2Q95
4t)7) 398-0151 FloddallotaryServloe.com SEP 2 0 2020
i
I
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood,. Sanford,
Seminole County, Winter Springs
Date: 5- 1- I �,
i hereby name and appoint: �d,
an agent of
(Name of Company)
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one.option):
fl''1, All permits and applications submitted by this contractor.
❑ The specific pern�it and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney: „) '�?/ a fir.
License Holder Name: CA
State License Number: P � a -G ?
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF � „-,
The foregoing instniment was ackno�.�ledged before me this day of�� 1
200N�al_, by C \'� �:;-� :� (� ';�`p who is ❑ persona y known
to me or ❑ who has produced v'L,__ \ n \ -CDC . \ "t �. as
identification and who did (did no to oath t`
Sig lre
r�
(Notary Seal)
Print or type name
PANAYOTTI PATRICIA
Notary Public -State of
MY COMMIs.SIC'N .R 00 931678
EYPIR[S:April 13, 2ol4 Commission No.
Bonded by CNA Surety m t�1y Comission Expires: _ F
(Rev. 3/27107)
i
4" ACCREDITED
BUSINESS
•L�1tJsi
R just makes sense...
210 Crown Point Circle; Suite 200, Longwood, FL 32779
Office: 321-972-4094 Fax: 321-972-4471
Toll Free: 877-294-6678 Fax: 877-294-2620
www.axiomcontracting.com FL License# CCC1329763
Job # FZ---// c2g
AGREEMENT
THIS AGREEMENT IS SUBJECT TO INSURANCE COMPANY APPROVAL OF PAYMENT
STREET f 2 Z L��
CITY 1sj..(Ldjl.� ST ZIP 72 i '7
HOME5607.-,U/00%, WORK
CELL ��i 2 �-/r r'�q` FAX
E-MAIL ADDRESS /)I .'S 441? L6Q
SOURCE (9
ACCOUNT REPRESENTATIVE j 0� -W b
PHONE NUMBER S 7;. G — 7 -r9 j
SPECIFICATIONS
94YPE OF TILE / SHINGLE -% a2ga—W21L,
❑-LOLOR OF TILE / SHINGLE
&VALLEY
❑ -VENTS
❑ STYLE
G`rEAR OFF ❑ YES. LAYER (S)
❑'-DITCH 112 STORY
EI-PtRMIT FURNISHED ❑ REPLACE ALL BOOT JACKS
9-tb FELT aICE & WATER SHIELD
F.REMOVE ROOF TRASH FROM ROOF, GUTTERS & YARD
SPECIAL INSTRUCTIONS
PAYMENT SCHEDULE
FIRST PAYMENT 50%
SECOND PAYMENT
FINAL PAYMENT DUE AFTER ROOF COMPLETED
CUSTOMER AGREES TO PAY AXIOM 15%
OF THE INSURANCE APPROVED DOLLAR AMOUNT
❑ ROLL YARD WITH MAGI`IETIC RO E IF CUSTOMER CANCELS AFTER THE INSURANCE
D-DRIP EDGE KEEP / REPLACE COLOR cP Lk-0 APPROVES PAYMENT'FOR THE DAMAGE INITIALS �.
TERMS:
THIS CONTRACT DOES NOT OBLIGATE THE PROPERTY OWNER OR AXIOM CONTRACTING GROUP LLC IN ANY WAY UNLESS IT IS
APPROVED BY THE PROPERTY OWNERS INSURANCE COMPANY AND ACCEPTED BY AXIOMCONTRACTINGGROUP LLC. BY SIGNING
THIS AGREEMENT THE PROPERTY OWNER AUTHORIZES AXIOM CONTRACTING GROUP LLC TO PURSUE THE PROPERTY OWNERS
BEST INTEREST FOR PROPERTY REPLACEMENT OR REPAIR AT A "PRICE AGREEABLE" TO THE PROPERTY OWNERS INSURANCE
COMPANY AND AXIOM CONTRACTING GROUP LLC WITH�NO ADDITIONAL COST TO THE PROPERTY OWNER OTHER THAN THE
INSURANCE DEDUCTIBLE. WHEN "PRICE AGREEABLE" HAS BEEN DETERMINED IT SHALL BECOME THE FINAL CONTRACT AMOUNT
AND THE PROPERTY OWNER AUTHORIZES AXIOM CONTRACTING GROUP LLC .TO OBTAIN LABOR AND MATERIAL IN ACCORDANCE
WITH THE "PRICE AGREEABLE" AND SPECIFICATIONS SET OUT HERIN AND ON THE REVERSE SIDE HEREOF TO ACCOMPLISH THE
REPLACEMENT OR REPAIR. THEREFORE AXIOM CONTRACTING GROUP LLC ACTING AS YOUR CONTRACTOR WILL BE ENTITLED TO
ALL INSURANCE PROCEEDS IN ACCORDANCE WITH THIS AGREEMENT. PROPERTY OWNER RECOGNIZES AXIOM CONTRACTING
GROUP LLC AS A GENERAL CONTRACTOR AND AS SUCH WILL BE ENTITLED TO 10% OVERHEAD & 10% PROFIT AS ALLOWED BY
INSURANCE INDUSTRY STANDARDS. ALL WORK WILL BE PERFORMED AT INSURANCE COMPANY RATES, FIGURES & MONEY. ALL
PRICES ARE SUBJECT TO CHANGE.
THE FINAL ROOF PRICE IS :THE RCV AMOUNT On INSURANCE PAPERWORK PLUS THE APPLICABLE CONTRACTORS
OVERHEAD AND PROFIT. CUSTOMER INITIALS
YOU, THE BUYER, MAY CANCEL THIS PURCHASE AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE
OF THIS AGREEMENT.
AXIOM CONTRACTING GROUP LLC CONTRACTING GROUP, INC. DISCLAIMS ALL WARRANTIES, EXPRESSED OR IMPLIED
WARRANTY OF MERCVANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE EXCEPT AS SPECIFICALLY EXPRESSED ON THE
REVERSE SIDE OF THIS AGREEMENT.
A
CUSTOMER HAS READ AND AGREES TO ALL TERMS AND CONDITIONS ON OF EEMENT
ACCEPTED BY HOMEOWNER(S) ON: DATE l l l 12--)�Y X�
CO-OWNER: DATE / / BY
ADJUSTER'S NAME.
AXIOIv1AEPRESENTATIVE: DATE Y BY X
sty
INSURANCE CO. CLAIM NO. a
y
Inspection Affidavit
I yM14e C'Z_ ,licensed as a(n) Contractor* [Engineer/Architect,
(please print name and circle Lic. Type) FS 468 Building Inspector*
License #; CC V /3 a 9,7 l 3
On or about _ 91,2_ y//�� 02 '�'d �/��- , I did personally inspect the roof
��'Date & time)
deck nailinz and/or secondary water barrier work at
(circle one)
(Job Site Address)
Based upon that examination I have deteAlned the installation was done according to the
Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S.)
'gn e
STATE OF FLORIDA
COUNTY 0175?�, `hDGQ ,
Sworn to and subscribed before me thist,,Yd/eday of 20Y/,;2-,
By
Notary Public, State of Florida C
+ p°s BONNIE J. MURRO��
Notary Public, State of Florida
Commission # EE 224619 �/�% i
My Comm. expires Sept.16, 2016 (Print, type or stamp name)
Commission No
Personally known or
Produced Identification [/
Type of identification produced. PL `� Z-/ �.
* General, Building, Residential, or Roofing Contractor or any individual certified under 468 F.S. to make such an
inspection. Include photographs of each plane of the roof with the permit # or address # clearly shown marked on the
deck for each inspection.